People wait their turn as others receive dental care during a clinic conducted by Remote Area Medical at Union County High School in Maynardville, Tenn. Remote Area Medical is a nonprofit organization whose volunteers offer free health care to the uninsured, the underinsured and the desperate.
Hannah's prayers have brought them here. Now there's little to do but turn up the car's heat, get some sleep and wait for morning - and a set of glass and metal doors to open.
Still, Hannah doesn't complain. The 26-year-old mother of three has waited "pretty much as long as I can remember" to escape the pain throbbing through her jaws. Jack lost his road construction job a year ago and health insurance is out of the question. If the answer to Hannah's misery lies behind those doors, what's 10 hours more?
Out in the dark, the Hursts have plenty of company. Even before 10 p.m. on this Friday in late fall, nearly 50 cars ring the lot. By 6 a.m. Saturday, more than 400 men and women stand tightlipped and bleary-eyed under the Big Dipper.
By day's end, as long as they keep tempers in check and sleep from their eyes, they will win the privilege of care from a dentist or a doctor.
In a country convulsed over health care, the scene is alarming. But it is always the same, Stan Brock says. For 17 years, Brock has piloted a nonprofit called Remote Area Medical, offering free health care to the uninsured, the underinsured and the desperate.
Brock has seen so many crowds like the one outside Union County High School he chides himself for losing track of whether this is RAM's 578th expedition or its 587th. Yet in every crowd, there are hundreds of Hannah Hursts, each a unique testament to the nation's ragged pursuit of health care answers.
Over the next two days, RAM's volunteers will examine, extract and prescribe hundreds of solutions for individual aches and afflictions. They will, in the few moments left, attempt to convince patients they'll probably never see again of the virtues of healthier living and continuous care. They will try to answer Hannah Hurst's prayers.
Lawmakers debating reform could almost certainly learn something here in the trenches.
But the most striking lesson might also be the most daunting: To fix health care inequities, expanding insurance alone may not be enough.
"Good morning folks," Brock booms in an accent crisp with authority. "We're going to get started on time."
It is precisely 6 a.m. and Brock has just pushed open the high school's doors, questions ready.
"Who's here to see a dentist?"
More than half raise their hands. Who needs an eye doctor? Almost as many. Who needs a medical doctor? Scattered hands go up, but Brock expects that, too.
"Really, they all need to see a doctor," he says. "They just don't want to lose their place on line."
Ronnie and Debbie Erwin have driven 2 hours from Johnson City. Insurance from her job covers his care for spinal stenosis. But the prescriptions caused his teeth to disintegrate and infection followed. Insurance doesn't cover that.
"My doctor said you've got to do something or it's going to kill you," Ronnie says.
Melissa Hayes, a home health aide from nearby Luttrell, has waited since 11:30 p.m. with her daughters, aged 5, 7 and 10. Her oldest, Brittney Prince, can't see the board at school, but the family can't afford glasses.
Joe Mason is anxious about a broken molar, but if there's time, he's thinking about seeing a doctor, too. The idea, though, leaves him uncertain.
"How do you go in there and talk to a doctor? I probably haven't been to one in 20 years," says Mason, 31.
"I mean, what are you supposed to say to one?"
Hannah Hurst is back for Day 2.
Yesterday, RAM's dentists pulled 16 of her teeth. In the gym, Trey Parker, a University of Louisville dental student, welcomes her return. But before reaching for his tools, Parker honors Hannah's request, linking hands with Jack and two other volunteers.
"Lord," Parker says, "let Hannah have the strength to bear through getting all her teeth pulled; that she can hold up; that her jaw will be made whole and that she can live a happier life being a mother. In the name of Jesus Christ."
"Amen."
Today is a bit of a gift. By 9 a.m., just 260 patients have come through the door. RAM's volunteers may get to everybody. But patients still fill the bleachers and line a hallway, a case study in needs health care reform may not answer.
Take Hannah Hurst's teeth. Proposals by Congressional Democrats, while they would greatly expand traditional medical coverage, won't cover dental care, except for children.
It's no better for vision care, not covered for adults under either the House or Senate bills.
Changing the economics, though, is just the start.
"There's a culture that sort of surrounds the problem," Brock says.
All the high blood pressure readings aren't a coincidence. Heart disease, hypertension and diabetes are serious problems throughout Appalachia. That is the result of smoking, lack of exercise, unhealthy diets and obesity, as well as relationships with the health care system, Behringer says.
It can be hard reaching a doctor in thinly populated counties with few roads and mountains. Many people don't see a doctor regularly and many doctors are unable to build the continuous relationships with patients to help ensure care.
The challenges are all too real to Eddie Graham, the local school health coordinator, who lobbied RAM to come to Maynardville. He recounts trying to foster health in an area where some families send children to class sick and tell them to go see the school nurse. Kids arrive at elementary schools carrying chewing tobacco.
Making health care affordable only partly solves problems like these, he says.
"It's changing beliefs," Graham says. "It's educating people about what is health."
When the numbers are totaled, Expedition No. 587 into America's health care jungle will be recorded as followed:
Over 1 days, 701 patients have come through RAM's doors.
Its dentists have extracted 852 teeth and filled 234 others; 345 pairs of eyes have been tested; 87 people have been examined by a medical doctor.
If RAM was going to send out a bill, it would total $138,370.
Does that make it a solution to a crisis or a symptom? The answer may lie beyond the bottom line.
When Brittney Prince goes back to school Monday, she'll be wearing her first pair of eyeglasses.
"Momma," she says, gazing outside, "the grass is not fuzzy any more."
And when Hannah Hurst - her toothless mouth stuffed with gauze - is helped from the chair, she hugs her caregivers. At church, raising money for dentures may have to wait until spring. But, at last, her prayers have been heard.
"There is no other answer for it but God and it just makes me so much more thankful," she says. "It truly is my testimony now. You keep praying, you keep asking, and your answer will be there sooner or later."
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